Listening and Supporting: The Spirituality of Nurses

The Cape Cod Times reported in mid-April that Julie Peterson, a per diem nurse, will not be hired by the Cape Cod Hospital again, following a conversation she had with a dying patient about religion. The patient’s family claims Peterson upset the patient by talking about repentance. Peterson says she was trying to mirror the patient’s comment in a conversation about dying, guardian angels, and the afterlife.

Regardless of what actually happened, the case raises broader questions about the extent to which and ways in which nurses talk with patients and families about spiritual and religious matters. While these topics are often discussed with hospital chaplains, it is not uncommon for them to come up with nurses—the hospital staff members who spend the most time with patients and families.

In research I conducted in a neonatal and adult medical intensive care unit at a large academic hospital, nurses gathered information about patients’ religious and spiritual backgrounds through nursing assessments they completed when patients were admitted to intensive care. They offered the services of the hospital chaplain as needed, especially if there were difficult decisions to make and in end of life situations.

Outside of these formal channels, families regularly initiated conversations with nurses about prayer, God, and spiritual and other rituals that might help their loved one. Many Americans draw on spiritual and religious beliefs to cope when a loved one is ill, both to try make sense of illness and to hope for recovery. Large numbers of Americans pray, and a recent survey published in the Archives of Surgery reported that close to 60% of the public and 20% of medical professionals think someone in a persistent vegetative state can be saved by a miracle.

In the neonatal ICU, it was not uncommon to see signs of families’ prayers and hopes in the New Testaments, Qur’ans, and Catholic medals actually in bed with the babies, in plastic bags labeled with their names. Families invited nurses to attend related rituals that took place in the intensive care units, and Catholic nurses sometimes agreed to serve as godparents for Catholic babies baptized in emergency situations.

The nurses I interviewed responded to family-initiated discussions about spirituality and religion more than they started them. Some stood quietly with patients and families when they were invited to pray, while others worked to support families when families talked about their spiritual or religious beliefs. Nurses negotiated their own comfort levels in such situations, striving, as a group, to care not just for their patients’ physical conditions but to support their psychological, emotional, and spiritual well-being—even when that spirituality was different from the nurse’s own.

Attention to spirituality is not uncommon among nurses. A recent survey of 299 nurses working at a university hospital found that 84% think there is something spiritual about the care they provide (in comparison to 24% who think there is something religious about the care they provide). Only 4% think that promoting spirituality is at odds with the real purpose of medicine.

Issues related to spirituality have long been a part of nursing curricula, with introductory textbooks often devoting a chapter to spirituality, and related topics being covered in chapters about caring, cultural diversity, grief, health promotion, and other topics. Upper-level courses also take up these themes, focusing more on spirituality (or that which gives people personal meaning) than on religion, defined in terms of religious institutions. Ethics codes, like the Code of Ethics for Nurses of the American Nurses Association, emphasize the importance of patients’ spiritual well-being and the NANDA International, which develops language around nursing diagnoses, recognizes three diagnoses related to spirituality and spiritual distress.

In medical and broader public discourse about religion, spirituality, and medicine, it is important not to overlook nurses’ support for the spiritual well-being of the patients and families in their care. While physicians and hospital chaplains talk with patients and families about these issues, it is nurses who are consistently at the bedside when the chaplains and physicians leave, listening and supporting. The majority of nurses do just that, listen and support.

The situation between Julie Peterson and her patient is unfortunate, but it is not common and need not overshadow the broader range of ways the nursing profession and the nurses I interviewed support their patients around spirituality and religion.